Evaluation of Recovery-Oriented Acute INpatient Mental Healthcare (RAIN-MH)

 Collaborators

  • Alan McGuire, PhD, HSPP
  • Michelle Salyers, PhD
  • Angela Rollins, PhD
  • Marina Kukla, PhD
  • Johanne Eliacin, PhD
  • Laura Myers, PhD
  • Nancy Henry, BA
  • Jennifer Garabrant, BSW
  • Jessica Carter, BS
  • Sarah Bauer, BA
  • Mindy Flanagan
  • Dawn Shimp

Outside Consultants 

  • Marcia Hunt, PhD
  • Gayle Iwamasa, PhD

Background:

Recovery-oriented inpatient mental healthcare holds the promise of substantial benefits for Veterans, yet there have been no published empirical investigations of the implementation of this important construct. Despite the paucity of evidence, the Veterans Health Administration (VHA) has mandated the provision of recovery-oriented inpatient mental healthcare. Although progress has been made, particularly in outpatient mental health services, recovery-oriented services within the VHA's acute mental health inpatient units represent a substantial implementation challenge. In 2013, VHA issued a Handbook for Inpatient Psychiatric Services and the accompanying Inpatient Services Toolkit. Recovery-oriented services likely represent a significant shift in milieu for many (if not most) acute care units, which have been more heavily focused on stabilization through medication management. In contrast, recovery-oriented services include broader goals, such as illness self-management education, shared decision-making, and access to evidence-based psychotherapy, all provided by an interdisciplinary treatment team. VHA policies supporting recovery-oriented inpatient care are consistent with the literature regarding patient preferences for person-centered care, but little is known regarding the impact these changes will have on Veterans, particularly following discharge. Moreover, the degree to which recovery-oriented services have penetrated VHA, and the factors impacting implementation, are unclear, making it difficult to understand what implementation supports may be needed. This project will examine the national rollout of recovery-oriented services on VHA inpatient mental health units and determine its impact on Veterans. 

Data regarding implementation of recovery-oriented elements, implementation processes, and Veteran outcomes will be collected from 34 VAMC acute inpatient mental health units using on-site observation, administrative data, and stakeholder interviews (staff and Veterans).  This study includes no research intervention, but rather utilizes observation and interviews regarding routine clinical practice. 

Objectives:

1) Examine the implementation of recovery-oriented services within VHA; 2) Describe the implementation process, including challenges and strategies to overcome them; and 3) Test the hypothesis that Veterans served by high recovery units will be more engaged in outpatient services and experience lower relapse rates than Veterans served by low recovery units.

Impact

The project is a partnership with the Office of Mental Health and Suicide Prevention (OMHSP, previously Office of Mental Health Operations) and strives to support VA’s pursuit of person-centered care for a vulnerable Veteran population. Results will provide OMHSP with information necessary for determining the need for, and target of, implementation supports. Results may also guide future efforts to measure the implementation of recovery-oriented inpatient care.